| Objective:To systematically review the published literature on iliosacral screws and lumbopelvic fixation in the treatment of posterior pelvic ring injuries caused by sacral fractures,and to compare the therapeutic effects of lumbopelvic fixation and sacroiliac screws.A systematic review of the diagnosis and treatment development of the two surgical techniques.Methods:According to the PRISMA reference guideline(preferred reporting item for systematic reviews and meta-analyses),a systematic search of Embase,MEDLINE,Cochrane Library and Zhiwang databases was performed,and the search terms were set as "iliosacral screws",synonyms for "lumbopelvic fixation" and related terms,etc,and the search deadline was set to March 2022,to search for studies comparing lumbopelvic fixation and iliosacral screw fixation in the treatment of posterior pelvic ring injuries,and to evaluate the quality of each included literature by MINORS Methodological Quality Assessment Scale,to score each included study.Using Revman version 5.4,the internal fixation loosening/dislocation rate,operation time,infection rate,neurological complications rate and Majeed score were statistically analyzed.The odds ratio(OR)was used to analyze the dichotomous data,and the mean difference(MD)of the 95%confidence interval(CI)was used to analyze the continuous data.Heterogeneity was assessed using the I2 statistic,where 25%,50%,and 75%were considered low,moderate,and high heterogeneity.Plot a forest plot to display the results.Differences were considered statistically significant when P<0.05.When I2>50%,a random effect model was used,and when I2<50%,a fixed effect model was used.Results:ln the combined analysis,the infection rate of the lumbar-pelvic fixation group was greater than that of the sacroiliac screw group(OR=0.14,95%CI:0.05-0.33,P<0.0001),and the operative time of the lumbar-pelvic fixation group was also greater than that of the sacroiliac screw group(MD=-76.46,95%CI:-96.59-56.33,P<0.00001).The failure rate of internal fixation in the sacroiliac screw group was greater than that in the lumbar-pelvic fixation group(OR=3.11,95%CI:1.18-8.20,P=0.02).The inclusion of internal fixation failure included internal fixation loosening,internal fixation misplacement,and internal fixation.breakage and loss of fixation,etc.The incidence of neurological complications(iatrogenic nerve irritation,nerve injury;OR=2.97,95%CI:0.67-13.14,P=0.15)and Majeed score excellent/yield rate(OR=1.93,95%CI:0.88)-4.23,P=0.10)were not statistically significant.In the funnel plot,the distributions of the individual analyses were approximately symmetrical,suggesting that the possibility of publication bias or other bias in the study is low..Conclusion:The minimally invasive nature of iliosacral screws makes them more widely used in clinical practice.Shorter operative times and lower infection rates make it easier for surgeons to apply iliosacral screws.For posterior pelvic ring injuries caused by traumatic sacral fractures,iliosacral screws are a more effective clinical application technique for targeted treatment compared with lumbopelvic fixation.We still recommend the use of iliosacral screws for fixation by skilled trauma orthopedists.However,there is still a lack of large single-center or multi-center clinical randomized controlled trials for the treatment of iliosacral screws and lumbopelvic fixation.More complete reporting of postoperative results and a more complete clinical scoring scale will promote the development of posterior pelvic ring injuries.Clinical decision making. |
